The Upper and Lower Extremities

Department of Internal Medicine Faculty of Medicine

Muhammadiyah University Yogyakarta

Nicotine Staining

Onychomycosis: Fungal Infection of the Nail

Onycholysis: Separation of Nail from Underlying Bed, often due to onychomycosis

Paronychia: Infection of skin adjacent to nail of middle finger

Peripheral Vascular Disease, Hand Tissue death (i.e. gangrene) of the fingers secondary to severe peripheral

vascular disease

Joint deformities secondary to rheumatoid arthritis

Clubbing associated with conditions that cause chronic hypoxemia

Cyanosis

Pitting edema Note divit left (pitting) after application of pressure.

Right upper extremity DVT. Note diffuse swelling

Lymph Nodes of the Upper Extremity

Palpation of Epitrochlear Lymph Nodes

Palpation of the Axilla

Left Axillary Adenopathy

The Femoral Region

The femoral pulse

Vascular Anatomy

The Popliteal Region

Below The Knee

Acute Arterial Insufficiency: Note Mottled Appearance of Skin

Chronic Arterial Insufficienc with Ulcers

Gangrene of Toes

Venous Insufficiency

Cellulitis

Assymetric Leg, Swelling secondary to Deep Venous Thrombosis in

Right Leg

Onychomycosis

Venous Stasis Ulcer

Neuropathic Ulcer in Patient with Diabetic Neuropathy

Clinical Osteomyelitis

Edema of Right Foot. Note Loss of Distinct Edges of Malleolous and Extensor Tendons

on Top of Foot

Massive edema. Note: Remaining imprint of fingers.

Lymphedema, Left Leg

Paronychia: Infection of the skin medial and inferior to nail of great

toe. Image on the right is post I&D

Location of Dorsalis Pedis Artery

Location of Dorsalis Pedis Artery

Palpating Dorsalis Pedis Artery

Location of Posterior Tibial Artery

Location of Posterior Tibial Artery

Palpating Posterior Tibial Artery

Using Doppler Device to Identify Posterior Tibial Artery

The learning pyramid

(www.arl.org)

10% of what they read 20% of what they hear 30% of what they see 50% of what they see and hear 70% of what they talk over with others 80% of what they use and do in real life 95% of what they teach someone else to do